Understanding the Basics
Medicaid is a government-run program that helps address exorbitant health care costs. As oppose to Medicare–which is a federal health insurance program for individuals over the age of 65 and certain individuals with disabilities—Medicaid is a joint state and federal assistance program that aids with medical costs for families and individuals with limited assets, resources or low incomes.
Medicaid helps low income families, poor individuals and pregnant women living below the nation’s poverty line secure medical care. Income levels—as oppose to age or disability—are the primary criteria to determine eligibility for Medicaid. Furthermore, unlike Medicare, Medicaid does not require specific contributions before one can access the benefits—entitlement is solely based upon need.
The administrative structure of Medicaid programs is different from Medicare. While Medicare is operated by the federal government, Medicaid is run primarily by the states—the program is simply backed by the Federal government in the form of 50-80% reimbursements of the funds paid-out by a state for Medicaid coverage. These funds are only delivered to individual states if they comply with requirements in the Federal statute regarding eligibility, services, estate recover and other matters associated with Medicaid.
Do I need a Medicaid Lawyer?
Medicaid lawyers are legal professionals who are experienced with state Medicaid laws. These legal professionals ensure that your application for Medicaid adheres to your state’s specific eligibility rules and regulations. Furthermore, a Medicaid lawyer will focus on helping low-income persons and their families with legal and financial planning for the transition to a nursing or medical facility.
Medicaid lawyers work with low-income families in need of asset protection for Medicaid qualification. To secure Medicaid benefits, low income families and individuals will need to deliver proper legal documentation to their respective state government. Since each case is unique, Medicaid lawyers use their skill-set and understanding of state Medicaid laws to offer a variety of services to clients in need.
Because each state implements their own eligibility requirements, your participation in a Medicaid program can be complex—rarely does an individual understand the laws associated with Medicaid. As a result of these intricacies, the hiring of Medicaid lawyers will prove beneficial—a Medicaid lawyer will ensure that your application not only meets your states filing requirements, but that your listed income and asset levels adhere to your state’s eligibility thresholds.
In general, a Medicaid lawyer will offer the following services and legal documentation for their clients:
• A Medicaid lawyer will explain and provide Miller Trust or Qualified Income Trust documents, which are needed in income cap states to qualify for Medicaid Services.
• Medicaid lawyers will help fill-out and file Medicaid Applications for those that qualify.
• Medicaid lawyers will offer spousal protection and homestead protection for those that qualify.
• Medicaid Lawyers may serve as Powers of Attorney for their clients.
In addition to these services, a Medicaid lawyer will elucidate the intricacies and complexities that are found in your state’s particular Medicaid laws. A Medicaid lawyer will help explain the following information:
Financial Eligibility Requirements:
In order to receive Medicaid benefits, an individual must affirm their financial need. A Medicaid lawyer can do this for you in a couple of different ways. Income standards for Medicaid are based on the Federal Government’s poverty level threshold. In cases where prospective medical expenses are extortionate an individual may be eligible for Medicaid even if the person’s income exceeds the standard qualification level.
Individuals who qualify—as medically needy–for Medicaid must pay a certain amount of their monthly income toward their medical costs before the benefits are made available. This is known as the “deductible”; in many states the deductible is assessed on the basis of a six-month eligibility period. This period requires the recipient to pay six months’ worth of deductible amounts before receiving benefits. If you are having difficulty with your underlying agency, Medicaid lawyers can explain, in detail, your state’s specific eligibility requirements and time constraints.
Asset standards for long-term Medicaid benefits in the majority of U.S. states are $2,000 for an individual and $3,000 for a couple. Some states; however, will institute different standards—consult with a Medicaid lawyer to observe your state’s specific figures.
Asset limits for a couple are different in nursing home or medical facility cases. The spouse of the recipient is permitted to retain part of the couple’s assets for his or her financial security; to learn more about how assets are counted for couples, please consult with a Medicaid lawyer in your area.
Penalties Associated with Medicaid:
Depending on your state’s rules and the kind of care you need, you may be disqualified from receiving Medicaid benefits for a period of time. These penalties revolve around your actions; if you gave property away to anyone other than your spouse in order to meet the Medicaid asset limits, you may be deemed ineligible. Asset transfers to qualify for nursing home benefits are deemed illegal in all states. Transfers to qualify for community benefits may or may not be subject to penalty, depending on your state’s regulations. Regardless of the Medicaid benefits sought, each state institutes its own regulations for determining how long the penalty lasts and what kinds of transfers of assets prompt penalization. Because of these regulations and the variance associated with each state’s unique laws, it is suggested you hire a Medicaid lawyer before applying for benefits.
As stated above, a Medicaid lawyer will ensure that your actions and your income/assets levels—as it pertains to your application fall in line with your state’s regulations. Adherences to your state’s Medicaid rules are required to obtain benefits.
